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Routine vaccination practice after adult and paediatric allogeneic haematopoietic stem cell transplant: a survey of UK NHS programmes

Bone Marrow Transplantation volume 52, pages 775–777 (2017)Cite this article

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A Corrigendum to this article was published on 05 July 2017

Despite advances in supportive care, infection remains a significant cause of morbidity and mortality post haematopoietic stem cell transplant (HSCT). Impaired humoral immunity, marked by a decline in Ab titres to vaccine preventable diseases (VPD), is observed within months and may continue for years post HSCT.1 HSCT recipients are at increased risk of morbidity and mortality from influenza virus infection and invasive pneumococcal disease,2, 3 two relatively common VPDs. The impact of declining Ab titres post HSCT on susceptibility to other VPDs is unclear, but cases of Haemophilus influenzae, pertussis and measles are documented.4, 5, 6 It is therefore considered best practice to try to offer HSCT recipients the same level of protection against all VPDs as the general population, and immunogenicity studies have demonstrated that post-HSCT Ab titres can be boosted by vaccination.7, 8, 9 FACT-JACIE International Standards for Haematopoietic Cellular Therapy require, therefore, that schedules are in place.10 To define this schedule of post-HSCT vaccination, UK HSCT programmes can refer to guidelines from several major societies, along with consensus conference proceedings and recommendations from national paediatric groups.11, 12, 13, 14 In the absence of supportive data, guidelines recommend standard vaccination schedules unmodified by disease indication, stem cell source or conditioning regimen, however, the specifics of the schedules vary across these guidelines.

We surveyed the adult and paediatric allogeneic HSCT (alloHSCT) programmes of the UK National Health Service (NHS) with the aim of assessing homogeneity of practice and determining how clinical care aligns with current evidence, recommendations and guidelines. We defined a routine vaccination programme (RVP) as a ‘series of scheduled vaccinations administered after alloHSCT as standard post-transplant care’ and developed a 25 question web-based survey, with questions grouped into four themes: RVP service organization, RVP vaccine selection, RVP commencement and delay, and monitoring of response to vaccines. Response options were mapped to current recommendations and guidelines, and respondents were asked specifically about current RVP practice. They were advised to refer to local guidelines or standard operating procedures (SOPs) when completing the survey. The survey was developed in conjunction with an infectious disease physician, senior adult and paediatric alloHSCT physicians, and alloHSCT nurse specialists all with an interest and expertise in vaccination. The survey was piloted with five HSCT specialists and optimized accordingly. An invitation to participate was e-mailed by the British Society of Blood and Marrow Transplantation to all 27 adult and 12 paediatric UK alloHSCT programme directors. Directors were invited to complete the survey or delegate to the health-care professional taking primary responsibility for RVP. The survey was open between May and December 2015.

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Authors and Affiliations

  1. Anthony Nolan Research Institute, Royal Free Hospital, London, UK

    P D E Miller, C Anthias & A Madrigal

  2. Department of Infection and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK

    T I de Silva

  3. Department of Paediatric and Adolescent Haematology and Oncology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK

    R Skinner

  4. Department of Clinical Haematology, Leeds Teaching Hospitals NHS Trust, Leeds, UK

    M Gilleece

  5. Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK

    A Peniket & A Hamblin

  6. Specialised Cancer Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK

    D Greenfield

  7. Department of Haemato-Oncology, Royal Marsden NHS Foundation Trust, London, UK

    C Anthias

  8. Department of Clinical Haematology, University College London Hospitals NHS Foundation Trust, London, UK

    K Peggs

  9. Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK

    J A Snowden

  10. Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK

    J A Snowden

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Correspondence to P D E Miller.

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Miller, P., de Silva, T., Skinner, R. et al. Routine vaccination practice after adult and paediatric allogeneic haematopoietic stem cell transplant: a survey of UK NHS programmes. Bone Marrow Transplant 52, 775–777 (2017). https://doi.org/10.1038/bmt.2016.362

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